Healthcare Provider Details

I. General information

NPI: 1720170665
Provider Name (Legal Business Name): KENNETH MARTIN BRADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 370
HOUSTON TX
77030-3004
US

IV. Provider business mailing address

6410 FANNIN ST STE 370
HOUSTON TX
77030-3004
US

V. Phone/Fax

Practice location:
  • Phone: 713-704-2238
  • Fax:
Mailing address:
  • Phone: 713-704-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number036147128
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberN6187
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number48184
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number036147128
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: